Background: Hospital medicine is a rapidly growing and advancing field. In 2020, pediatric hospital medicine became a board-certified specialty requiring successful completion of an ACGME accredited two-year fellowship and examination1. Adult hospital medicine fellowships, which do not require ACGME accreditation, have grown organically. We sought to characterize the current landscape of hospital medicine fellowships.

Methods: The Society of Hospital Medicine website was used to identify all publicly advertised adult hospital medicine fellowships in the United States. We developed a 99-field survey in REDCap, which was administered via email and the SHM HMX Daily Digest email message board. Data were de-identified and analyzed using descriptive statistics.

Results: Out of 40 programs contacted, 18 (45%) programs responded. Of the 18 programs who responded, 15 (83%) were active and 3 (17%) were in planning stages. The majority (94%) of program respondents identified as academic medical centers (89%), university hospitals (56%), and/or teaching hospitals (61%). The median age of active, adult hospital medicine fellowship programs was 4.5 years (IQR 6.5), and median number of fellows to have ever completed the program was 3.5 (IQR 8.5). All 18 fellowships were either one year (44%) or two years (39%) with three fellowships (17%) offering a choice between one and two years. The majority (94%) of programs identified as having focus areas in research (66%), quality improvement (61%), medical education (66%) and/or clinical medicine (61%). Three programs reported focus areas in POCUS, three in healthcare administration and one program each had a focus in informatics, public health or global health (Table 1). The most frequent compensation for fellows was between $60k and $70k per year (39% of programs). A median of 50% of fellows’ time (IQR 0.08) was spent in clinical activities, with 80% (8/10) of fellows producing between 1501-2500 wRVU per year, evenly split between 1501-2000 and 2001-2500 wRVU per year. The majority (72%) of programs offered opportunities to obtain a master’s degree or complete other post-graduate coursework with one third of programs requiring an advanced degree. The majority (67%) of programs reported that their fellows went on to careers in academic medical centers (Table 2).

Conclusions: While significant heterogeneity exists across adult hospital medicine fellowships with regards to program characteristics, infrastructure and outcomes, the majority of programs have a focus on research, quality improvement, clinical medicine and medical education. Fellowship trained hospitalists gain the time, mentorship and opportunities needed to develop specialized skills and knowledge, which they leverage into scholarly productivity and careers in academic hospital medicine. In the future, adult hospital medicine fellowships may evolve towards standardized curricula and ACGME accreditation, potentially acting as vehicles for board certification.

IMAGE 1: Table 1. Fellowship Characteristics

IMAGE 2: Table 2. Fellowship Outcomes